Healthcare Provider Details

I. General information

NPI: 1346368628
Provider Name (Legal Business Name): DR. MARK S HEPPE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E 3RD ST
LIBBY MT
59923-2056
US

IV. Provider business mailing address

214 E 3RD ST
LIBBY MT
59923-2056
US

V. Phone/Fax

Practice location:
  • Phone: 406-293-9274
  • Fax: 406-293-9280
Mailing address:
  • Phone: 406-293-9274
  • Fax: 406-293-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4891
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: